Symptom Presentation and Symptom Meaning Among Traumatized Cambodian Refugees: Relevance to a Somatically Focused Cognitive-Behavior Therapy

Abstract

Among psychologically distressed Cambodian refugees, somatic complaints are particularly prominent. Cambodians interpret anxiety-related somatic sensations in terms of "Wind" (khyâl), an ethnophysiology that gives rise to multiple catastrophic interpretations; and they have prominent trauma-memory associations to anxiety-related somatic symptoms. In this article, we detail some of the common sensation-related dysphoric networks of Cambodian refugees, focusing on catastrophic cognitions and trauma associations. We argue that delineating symptom-related dysphoric networks is crucial to successfully adapt cognitive-behavioral interventions to treat panic disorder and posttraumatic stress disorder among Cambodian refugees, and that such an approach may be useful for the culturally sensitive adaptation of cognitive-behavior therapy for other traumatized nonWestern groups.The Current Article discusses how a somatic-focused cognitive-behavior therapy can be applied to the treatment of traumatized Cambodian refugees and, more generally, to nonEnglish-speaking traumatized refugees. The article demonstrates that such a treatment approach must be based on a complex model of the generation of somatic symptoms among trauma victims.

Panic disorder in rural Tanzania: an explorative study

“…This finding is consistent with findings from patients with PD in Southeast Asia and North America. 9,10 Furthermore, the main focus on bodily PD-symptoms in present setting were consistent with reports from Western countries, in which 85% of patients with PD primarily presented physical symptoms. 11 The most frequently reported catastrophic cognitions were: "I will die," and "I will faint", and fear of becoming paralyzed.…”

The Panic Attack–Posttraumatic Stress Disorder Model: Applicability to Orthostatic Panic Among Cambodian Refugees

“…The model is also useful when assessing the general predisposition to panic attacks for a particular patient or patient group: the total severity the "TCMI"-type dysphoria networks concerning somatic and psychological symptoms of anxiety should be predictive of predisposition to panic attacks. (As discussed above, the ASI would be one way to quickly assess the degree of "fear of anxiety symptoms" that results from TCMItype dysphoria networks [Hinton and Otto, 2006].) The Panic Attack-PTSD Model is a useful heuristic to explore the generation of panic attacks, and the relationship to PTSD severity; such knowledge will give insights into how to design treatment (e.g., reducing anxious-depressive distress through relaxation techniques; modifying catastrophic cognitions; and eliciting trauma associations).…”

“…Anxiety may then escalate (E) to the point of panic. (We believe that "fear of anxiety symptoms" assessed by instruments such as the Anxiety Sensitivity Index [ASI] is generated by these four types of dysphoric networks [see Hinton and Otto, 2006]. )…”

“…It provides insights into which traumatized patient groups and which traumatized cultural groups would be expected to have elevated rates of panic attacks and unique panic subtypes. The model also explains how panic attacks worsen PTSD severity and provides invaluable insights into how to treat those panic attacks in order to reduce PTSD severity [see Hinton et al, 2005a;Hinton and Otto, 2006]. Below we will show how the Panic Attack-PTSD Model applies to orthostatic panic among Cambodian refugees.…”

“…For example, Cambodians often describe negative life events in dizziness tropes: if a child becomes gang involved, the patient will say that the child "shakes me" (grolok khnyom), or that the child causes him or her to have a "spinning brain" (lop khue) [Hinton and Otto, 2006]. Owing to these metaphors, thinking about such life events may induce dizziness, and dizziness may evoke these life events.…”